# Lichen planus (cutaneous) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: BAD Guidelines for Lichen Planus · Dermovate (clobetasol propionate 0.05%) Cream SmPC section 4.2 (eMC product 939) · Prednisolone 5mg tablets SmPC (https://www.medicines.org.uk/emc/product/4921/smpc) · Lichen Planus - StatPearls - NCBI Bookshelf (NBK526126) - Verified date: 2026-08 ## Verified against - Dermovate (clobetasol propionate 0.05%) Cream SmPC section 4.2 (eMC product 939) - Prednisolone 5mg tablets SmPC (https://www.medicines.org.uk/emc/product/4921/smpc) - Lichen Planus - disease-level clinical article (lichen-planus-clinical.txt) ## Treatment metadata - Clobetasol propionate — topical - Referral & safety-netting (no drug therapy) - Prednisolone — 5 mg — oral.solid - Metronidazole — 500 mg — oral.solid - Triamcinolone acetonide — injection ## Complete treatment card ```text LICHEN PLANUS (CUTANEOUS) Sources: BAD Guidelines for Lichen Planus · Dermovate (clobetasol propionate 0.05%) Cream SmPC section 4.2 (eMC product 939) · Prednisolone 5mg tablets SmPC (https://www.medicines.org.uk/emc/product/4921/smpc) · Lichen Planus - StatPearls - NCBI Bookshelf (NBK526126) Review status: REVIEWED against Dermovate (clobetasol propionate 0.05%) Cream SmPC section 4.2 (eMC product 939), Prednisolone 5mg tablets SmPC (https://www.medicines.org.uk/emc/product/4921/smpc), Lichen Planus - disease-level clinical article (lichen-planus-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (9) - Itching is typical of the classic papules [itching · papules] - Painful, erosive lesions on the soles or between the toes can make walking difficult - Burning pain worsened by hot or spicy food occurs with the erosive and atrophic oral forms [atrophy · burning pain] - Oesophageal involvement can cause difficulty swallowing [difficulty swallowing] - Most people with skin lesions clear spontaneously within 1 to 2 years of first coming in [skin lesions] - The oral form is a different animal - it is chronic, and may or may not remit - A remission won on treatment is typically followed by relapse, so symptomless oral disease is better left alone - the side-effects of treating it cost more than the disease does [relapse] - Drug-induced lichen planus resolves gradually once the medicine behind it is stopped - The drug-induced form can be impossible to tell apart from the idiopathic kind SIGNS - what you find (12) - Lesions follow the 6 P's: purple, polygonal, flat, itchy papules and plaques [itching · papules · plaques] - A shiny surface with fine white lacy lines (Wickham striae) is a hallmark, and lesions feel firm [stretch marks] - Lesions typically cluster on the flexor wrists, backs of the hands, lower back, ankles, and shins - New lesions can appear along scratch lines, the Koebner phenomenon [skin lesions] - Resolved lesions often leave grey-brown pigmentation behind - The hypertrophic form shows thickened, wart-like red-brown or yellow-grey plaques on the shins and ankles [plaques] - Bullous lichen planus produces tense blisters on the legs filled with clear or pale-yellow fluid [blisters · pallor] - The most common oral form (reticular) is symptomless white lacy lines on the inner cheeks - Nail disease starts with a thinned plate and lengthwise ridging, and can progress to scarring and nail loss [scarring] - Scalp disease (lichen planopilaris) shows small red follicular bumps that progress to scarring hair loss [hair loss · scarring] - Drug-induced lichen planus favours sun-exposed skin rather than the classic sites - Erosive vulval or vaginal disease can leave scarring and narrowing [scarring · stricture] TESTS (4) - Dermoscopy shows Wickham striae as white lines with red globules at the edge - Patch testing is used when oral lesions sit near dental fillings to check for a metal allergy - Biopsy with microscopy is the most reliable way to confirm the diagnosis - Direct immunofluorescence on biopsy helps separate lichen planus from lupus IF NOT THIS - what else fits (10) - Lupus erythematosus is hard to distinguish when only scalp or mouth lesions are present, so biopsy with immunofluorescence is used - Hypertrophic lichen planus can closely resemble lichen simplex chronicus - Vulvar lichen planus can be hard to tell apart from lichen sclerosus - Erythema dyschromicum perstans (ashy dermatosis) - Psoriasis - Secondary syphilis - Pityriasis rosea - Lichen nitidus - Graft-versus-host disease - Keratosis lichenoides chronica Source StatPearls "Lichen Planus" - disease-level clinical article Status traced to the source above Rx: Main treatment | Oral second-line when the topical steroid has not worked | Intralesional injection into plaques that resist clobetasol MAIN TREATMENT - choose one 1. CLOBETASOL PROPIONATE [1st line] Adult Apply 0.05% ointment thin layer twice daily to pruritic violaceous papules x 2-4 weeks Peds Child: use moderate-potency topical steroid (e.g. clobetasone butyrate 0.05%) under specialist supervision Source Dermovate (clobetasol propionate 0.05%) Cream SmPC section 4.2 (eMC product 939) Why Superpotent topical corticosteroid that suppresses the immune-mediated inflammation driving the pruritic, violaceous papules of cutaneous lichen planus. Caution Clobetasol propionate is a superpotent topical corticosteroid; do not use continuously for >4 weeks without medical review. Avoid face, axillae, and groin. Screen for hepatitis C virus infection in patients with extensive lichen planus. Ceilings the label sets: no more than 50 g in a week, no longer than 4 weeks, courses kept to about five days where possible and reviewed weekly. If it is still needed after that, step down to a weaker steroid and keep an emollient going. Clobetasol is the most potent class - atrophy and adrenal suppression are the price of open-ended use. Egypt CLOBITAT 0.05% TOPICAL CREAM 15 GM BIORIGINAL INTERNATIONAL GROUP PHARMA... 5.50 EGP DERMASOL 0.05% CREAM 20 GM UP PHARMA 5.50 EGP DERMASOL 0.05% OINT. 20 GM UP PHARMA 5.50 EGP CLEROVATE 0.05% TOPICAL OINT. 25 GM MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) 7.50 EGP CLOVACORT 0.05% OINT. 20 GM EUROPEAN EGYP... 9.00 EGP DERMOPHARM 0.05% CREAM 25 GM WESTERN PHARM... 22.00 EGP DERMOVATE 0.05% TOP. CREAM 25 GM GLAXO SMITHKLINE 44.00 EGP HEROBETASOL 120 MLSHAMPOO EGPI > HEROPHARM 37.50 EGP 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Lichen Planus - disease-level clinical article (lichen-planus-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - There is a risk of malignant transformation of oral mucosal lesions into oral squamous cell carcinoma. 3. PREDNISOLONE [2nd line] Adult 30-40 mg once daily for 1-2 weeks, then taper over 3-4 weeks for severe or widespread involvement x 4-6 weeks (tapering course) Peds Specialist pediatric dermatology consultation mandatory Source Prednisolone 5mg tablets SmPC (https://www.medicines.org.uk/emc/product/4921/smpc) Why Reserved for severe, widespread, or disabling lichen planus unresponsive to topical steroids Caution Short-term systemic corticosteroid side effects include mood swings, insomnia, elevated blood glucose, and hypertension. Do not stop abruptly after >2 weeks of continuous therapy. Egypt HOSTACORTIN H 5MG 30 TAB. SANOFI 12.00 EGP (0.40/unit) PREDNISOLONE 5 MG 20 TABS. ARAB DRUG COM... 24.00 EGP (1.20/unit) PREDILONE 5MG 10 TAB. (25 STRIPS PACK) KAHIRA 250.00 EGP (25.00/unit) EPICOPRED 5 MG 30 ORODISPERSIBLE TABS. EIPICO 69.00 EGP PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS. EVA PHARMA 79.50 EGP DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS. ANDALOUS PHARMA 84.00 EGP SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS. SANOFI WINTHROP > SANOFI 84.00 EGP ACETASEE 1% EYE DROPS (SUSP.) 5 ML RAMEDA 7.50 EGP -> ? strength differs, ? different route - not oral solid PREDNIS 5MG/5ML SYRUP 100 ML PHAROPHARMA 9.50 EGP -> ? strength differs, ? different route - not oral solid ORAL SECOND-LINE WHEN THE TOPICAL STEROID HAS NOT WORKED 4. METRONIDAZOLE [2nd line] Adult 500 mg twice a day x 3 to 8 weeks Peds No paediatric dose for this indication in the sources opened. Source Lichen Planus - StatPearls - NCBI Bookshelf (NBK526126) Why It gives the card something between a failed topical steroid and a course of oral prednisolone. The drug is cheap, needs no blood monitoring, and every Egyptian pharmacy has it. The evidence behind it is small, so offer it as an option to try rather than the expected next step. Caution Tell the patient plainly not to drink any alcohol during the course or for a few days after it, because the combination causes violent flushing and vomiting. This is a long course for metronidazole - stop it at once if the patient reports numbness or pins and needles in the hands or feet, which can signal nerve damage. Avoid it in the first trimester of pregnancy. The evidence for metronidazole in lichen planus is limited, so review at the earlier end of the range and stop if nothing has changed. Egypt DUMOZOL 500MG 20 F.C. TABS. MINA PHARM > ... 7.00 EGP (0.35/unit) ZOLGUARD 500MG 20 TAB. UNIPHARMA CO.... 9.00 EGP (0.45/unit) NITROFECTAZOLE 500 MG 20 F.C. TABS. GYPTO PHARMA 10.50 EGP (0.53/unit) FLAGICURE FORTE 500 MG 20 F.C. TAB KAHIRA 23.00 EGP (1.15/unit) TRICHOGYL 500MG 12 F.C.TAB. EL NASR 15.00 EGP (1.25/unit) FLAGELLAT FORTE 500MG 20 F.C.TABS. MUP 30.00 EGP (1.50/unit) GEDAZOLE 500MG 20 TAB. JEDCO INT. CO... 34.00 EGP (1.70/unit) METROGYPTON 500 MG 20 F.C. TABS. GYPTO PHARMA 34.00 EGP (1.70/unit) DUMOZOL 125MG/5ML SUSP. 125ML MINA PHARM > ... 5.75 EGP -> ? strength differs, ? different route - not oral solid METROZOLE 125MG/5ML SUSP. 120 ML MEMPHIS 19.50 EGP -> ? strength differs, ? different route - not oral solid INTRALESIONAL INJECTION INTO PLAQUES THAT RESIST CLOBETASOL - give alongside 5. TRIAMCINOLONE ACETONIDE [add-on - not a substitute] Adult Injected into the lesion at a strength of 5 to 10 mg/mL Peds No paediatric dose in the sources opened. Source Lichen Planus - StatPearls - NCBI Bookshelf (NBK526126) Why For the patient with a handful of thick, itchy plaques that clobetasol has not flattened, injecting the steroid straight into them treats the lesion without exposing the whole body to a course of oral steroid. It is done in the clinic in a few minutes. Caution The ampoule sold in Egypt is far more concentrated than the strength quoted here and must be diluted with saline or local anaesthetic before it is injected into skin. Injecting too much, too often, or too superficially thins the skin and leaves a pale dented scar that may be permanent - keep to a few resistant plaques. Do not inject into skin that looks infected. This treats individual lesions; it does nothing for widespread disease, which needs the oral route or referral. Egypt PHARCOCINOLONE 40MG/ML I.M AMP. CHEMIPHARM > ... 8.00 EGP AMCINOL 40MG/ML I.M AMP. SIGMA TEC 11.00 EGP EPIRELEFAN 40MG/ML I.M AMP. EIPICO 38.00 EGP SYNTHECORTIN 40MG/ML I.M AMP. MUP 54.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)